Provider Demographics
NPI:1558845859
Name:THROMBLEY, EDWARD GEORGE III (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:GEORGE
Last Name:THROMBLEY
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 GEER RD # 200
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1146
Mailing Address - Country:US
Mailing Address - Phone:209-668-3063
Mailing Address - Fax:
Practice Address - Street 1:3800 GEER RD # 200
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1146
Practice Address - Country:US
Practice Address - Phone:209-668-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant